Comparative effectiveness of antitumour necrosis factor agents, biologics with an alternative mode of action and tofacitinib in an observational cohort of patients with rheumatoid arthritis in Switzerland
| Autor: | Finckh, Axel, Tellenbach, C, Herzog, L, Scherer, A, Moeller, B, Ciurea, A, von Muehlenen, I, Gabay, Cem, Kyburz, D, Brulhart, Laure Sophie, Müller, R, Hasler, P, Zufferey, P, physicians and patients of the SCQM (Swiss Clinical Quality Management in Rheumatic Diseases) |
|---|---|
| Přispěvatelé: | University of Zurich, Finckh, A |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Piperidines/therapeutic use 2745 Rheumatology lcsh:Medicine Antirheumatic Agents/therapeutic use Kaplan-Meier Estimate Arthritis Rheumatoid chemistry.chemical_compound 615: Pharmakologie und Therapeutik 0302 clinical medicine Piperidines Risk Factors biological therapies Immunology and Allergy Biological therapy Longitudinal Studies Prospective Studies Registries 030212 general & internal medicine Comparative effectiveness research ddc:616 10051 Rheumatology Clinic and Institute of Physical Medicine Middle Aged Tocilizumab Arthritis Rheumatoid/drug therapy Antirheumatic Agents Rheumatoid arthritis Cohort 2723 Immunology and Allergy Female Switzerland Cohort study medicine.drug Adult medicine.medical_specialty Immunology 610 Medicine & health Risk Assessment Abatacept 03 medical and health sciences Rheumatology Tumor Necrosis Factor Inhibitors/therapeutic use Internal medicine medicine Janus Kinase Inhibitors Humans tumour necrosis alpha inhibitors Aged 030203 arthritis & rheumatology 2403 Immunology Tofacitinib business.industry lcsh:R Janus Kinase Inhibitors/therapeutic use Pyrimidines/therapeutic use medicine.disease Abatacept/therapeutic use Pyrimidines Logistic Models chemistry Concomitant 616.7: Krankheiten des Bewegungsapparates und Orthopädie Tumor Necrosis Factor Inhibitors business Tumour necrosis alpha inhibitor |
| Zdroj: | RMD Open, Vol. 6, No 1 (2020) P. e001174 RMD Open RMD Open, Vol 6, Iss 1 (2020) |
| ISSN: | 2056-5933 |
| Popis: | BackgroundMultiple biologic and targeted synthetic disease-modifying rheumatic drugs (b/tsDMARDs) are approved for the management of rheumatoid arthritis (RA), including TNF inhibitors (TNFi), bDMARDs with other modes of action (bDMARD-OMA) and Janus kinase inhibitors (JAKi). Combination of b/tsDMARDs with conventional synthetic DMARDs (csDMARDs) is recommended, yet monotherapy is common in practice.ObjectiveTo compare drug maintenance and clinical effectiveness of three alternative treatment options for RA management.MethodsThis observational cohort study was nested within the Swiss RA Registry. TNFi, bDMARD-OMA (abatacept or anti-IL6 agents) or the JAKi tofacitinib (Tofa) initiated in adult RA patients were included. The primary outcome was overall drug retention. We further analysed secondary effectiveness outcomes and whether concomitant csDMARDs modified effectiveness, adjusting for potential confounding factors.Results4023 treatment courses of 2600 patients were included, 1862 on TNFi, 1355 on bDMARD-OMA and 806 on Tofa. TNFi was more frequently used as a first b/tsDMARDs, at a younger age and with shorter disease duration. Overall drug maintenance was significantly lower with TNFi compared with Tofa [HR 1.29 (95% CI 1.14 to 1.47)], but similar between bDMARD-OMA and Tofa [HR 1.09 (95% CI 0.96 to 1.24)]. TNFi maintenance was decreased when prescribed without concomitant csDMARDs [HR: 1.27 (95% CI 1.08 to 1.49)], while no difference was observed for bDMARD-OMA or Tofa maintenance with respect to concomitant csDMARDs.ConclusionTofa drug maintenance was comparable with bDMARDs-OMA and somewhat higher than TNFi. Concomitant csDMARDs appear to be required for optimal effectiveness of TNFi, but not for bDMARD-OMA or Tofa. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|